Substance Use Disorders Flashcards
“When a dose of a medication gives less effect over time” is the definition of ___
Tolerance
“When decreased doses of a medication leads to withdrawal symptoms” is the definition of ___
Physical dependence
“Drug use exceeding recommended therapy which leads to increased adverse effects” is the definition of ___
Drug abuse
What are the “Five Cs” of addiction?
Compulsive Chronic decreased Control Continued use Cravings
What scheduled control is cocaine?
Schedule II
What is the MoA of cocaine?
Prevents reabsorption of 5HT, NE, EPI, and DA
How is cocaine withdrawal treated?
Supportive care, fluids, multivitamins+B+C
True or False? There are no FDA-approved medications to treat cocaine use disorder
True. Psychosocial therapy is first-line
___ converts acetaldehyde to acetic acid
Aldehyde dehydrogenase
What is the MoA of disulfuram?
Disulfuram inhibits aldehyde dehydrogenase, which causes a buildup of acetaldehyde and makes the patient feel sick if they ingest alcohol
Disulfuram is contraindicated with ___ and ___
Ethanol
Metronidazole
What is the BBW of disufuram?
Do not administer to an alcohol intoxicated patient (< 12 hours since last drink) or without their full knowledge
What is the MoA of acamprosate?
Acamprosate decreases cravings for alcohol
Acamprosate is contraindicated in ___
CrCl < 30
What is the dose for acamprosate?
666mg TID
If CrCl is between 30-50, 333mg TID
What is the MoA of naltrexone?
Naltrexone decreases cravings for alcohol
Naltrexone is contraindicated with ___
Opioid use
What is the dose for naltrexone?
PO: 50-100mg/day
IM: 380mg every 28 days
What is the mechanism of topiramate?
Increases GABA and decreases cravings for alcohol
True or False? Topiramate is FDA approved for the treatment of alcohol use disorder
False. It decreases cravings, but is not FDA approved for treatment of alcohol use disorder
How do you treat alcohol withdrawal?
To prevent wernicke-korsakoff syndrome, give folate, thiamine (B1), multivitamin, crystalloid fluids (D5W+KCl), benzodiazepines
What are the three opioid receptors?
Mu, Kappa, Delta
What medication is an opioid antagonist used for reversing opioid overdose?
Naloxone
What is the acronym for the opioid withdrawal scale?
COWS
What medications are used for maintenance of opioid use disorder?
Naltrexone (mu opioid antagonist)
Methadone: CII (full mu opioid agonist)
Buprenorphine: CIII (partial mu opioid agonist)
What is the MoA of naloxone
Mu antagonist
JB is going to be induced on Suboxone. What would you tell him about how Suboxone works? It is a:
a. Mu agonist
b. Mu antagonist
c. Partial mu agonist
B & C. Mu antagonist and partial mu agonist
SB is a 33 yo F with a history of alcohol use disorder. SB states she drinks 1 liter of vodka daily. She reports alcohol is her drug of choice, but also states she uses $50 worth of heroin every few days. She presents to inpatient substance use program for treatment of alcohol and heroin. What medication would be preferred for SB?
a. Methadone
b. Naltrexone
c. Acamprosate
d. Topiramate
B. Naltrexone is FDA indicated for both alcohol use disorder and opioid use disorder
What are examples of depressants?
Alcohol Benzodiazepines Barbiturates Sedative-hypnotics Opioids Cannabis
What are examples of stimulants?
Caffeine
Cocaine
Amphetamine/Methamphetamine
MDMA/Ecstasy
What are examples of hallucinogens?
Lysergic acid diethylamide (LSD) Psilocybin (mushrooms) DMT Mescaline (peyote) Phencyclidine (PCP)
What are the effects of stimulant intoxication?
Tachycardia or bradycardia Pupillary dilation Elevated or lowered blood pressure Perspiration or chills Nausea or vomiting Evidence of weight loss Psychomotor agitation or retardation Muscular weakness Respiratory depression, chest pain, or cardiac arrhythmias Confusion, seizures, dyskinesias, dystonias, or coma
What are symptoms of alcohol withdrawal?
Tachycardia Hypertension Anxiety Dysphoria N/V Tremors Anxiety Confusion, agitation, fever, and/or seizures if prolonged
What are symptoms of opioid withdrawal?
NV Stomach cramps Diarrhea Goosebumps Depression Drug cravings
LB is a 27 yo M with PMH of migraines. LB presents to the ED sweating, nauseous, and very agitated. BP:172/90; HR: 86; T: 98.9
Which of the following substances may be the offending agent?
a. Heroin
b. Alcohol
c. Cocaine
d. Oxycodone
c. Cocaine
